Medical treatment of glaucoma : A study on one drop topical applications of pilocarpine 2% and levobunolol 0.5% and the normal diurnal intraocular pressure variation at the Kenyatta National Hospital

Abstract

In this'controlled study, one drop intraocular pressure curves were plotted for 50 oatients over 6 hours. the patients were treated with levobunololO.5%, pilocarpine 2%, levobunolol/pilocarpine combined and placebo. It was found that levobunolol produ~ed some effects on the cardiovascular system, lowering pulse rate and blood pressure to a statistically significant but clinically insignificant degree, while pilocapine had no such effects. The magnitude of response to treatment was larger with levobunolol than with pilocarpine and the two when used together had an additive effect.

Onset of action was more prompt,with pilocarpine but

its ocular hypotensive effect was short lived as the lOP started rising again after 4 hours, while levobunolol continued to lower the lOP upto the 6th hour. At 2 hours the lOP fall was 83.7% of the total fall for levobunolol while it was 100% for pilocarpine. Levobu­ nolol produced a contralateral effect when tonically applied to one eye while pilocarpine did no~ and for both drugs the magnitude of response appeared to be directly proportional to the pre-treatment intraocular pressure level. As for the normal diurnal lOP variation, the mean amplitude of variation was found to be 4mmHg with the lOP being highest in the morning at 6 am and lowest in the the evening at 6 pm in the 40 eyes studied.